Pediatric Head Injuries

[Mistify]

I also posted this in the pediatric group but I would like ER nurses opinions as well. I am a surgical nurse(at home mom right now) and a friend of mine that is a pediatric nurse. We were discussing the issue of pediatric head injuries and we have heard different opinions on the issue. Should a child that takes a major impact to the head be allowed to sleep before getting a neuro exam, a med/surg nurse told us it is just an old wives tail, but I know when I worked ER we never let a patient sleep before getting a neuro exam after a head injury, who is right here? I have been a stay at home mom for the last year but I did not think things had changed that much. Any help would be appreciated.Thanks

[GilaRRT]

How does sleeping adversely effect the central nervous system of the patient with a suspected brain injury? What is the rationale for not allowing people to sleep? If you cannot wake somebody up for a neuro exam you have problems, but not allowing somebody to sleep?

[kessadawn, BSN, RN]

my patients can't help but to fall asleep sometimes, and i let them. try explaining to a 2 year old he's got to stay awake. impossible. if i can't wake them up for the next neuro check, that's when i worry.

[RazorbackRN, BSN, RN]

I think a lot of it depends on the parent and the enviroment. If we admit the kid to the hospital, of course we let them go to sleep. We just really watch the neuro status closely by waking them frequently for neuro checks.

If the kid is not going to be under medical supervision or is at home, we do tell the parents to keep the child awake. This is not necassarily because we're afraid something bad will happen if the child sleeps, but because parents would be much more likely to notice a neuro change in a child who is awake, rather than just attributing the decreased LOC to the child being asleep.

[Shed13911]

I work for a pediatric telephone triage center in Texas. The guidelines we use for pediatric head traumas are that the child is allowed to sleep if they were either due for a nap or it was bedtime and they were tired before the injury. The parents have to keep them under close supervision to make sure they are resting comfortably and stable while asleep. If they sleep past 2 hours, the parents are instructed to wake them up and make sure they can respond appropriatly for age. They have should no nuerological changes and behave normally.

However, if they were not due for a nap or tired before the injury, and they suddenly act very sleepy and are drifting off, that may be signs of possibly a more serious head injury. Those children are sent to the ER stat and may need a CT scan of the head to asess further for a more serious injury.

I believe the reason the questions about letting someone sleep after a head injury are related to "old school." Our parents and grandparents were taught that you had to keep them awake for 2 hours after a head unjury because if the person went to sleep, they may not wake up again. However, that reasoning doesn't really make any differance. You can have a delayed negative responce up to 72 hours after a head injury. You have a 72 hour window that parents are instructed to watch for sx. they are told to watch for specific symptoms. If the child is very fussy/irritable/complaining of severe headache, they need to be seen(no pain meds for anyone after a head injury because if their head hurts that bad, they need to be seen). Also, if there are any nuerological changes, or they vomit 3 times or more within the 72 hours(no matter how far apart the emesis occur.)

I believe the guidelines we follow are written by Barton-Schmidt.